A Conversation With
A Conversation with Dr. Angela Mariotto and Dr. Martin Brown on the Rising Costs of Cancer Care
A new study from researchers in NCI’s Division of Cancer Control and Population Sciences (DCCPS) published January 12 in the Journal of the National Cancer Institute projects that the cost of caring for the U.S. population of cancer patients and survivors will increase substantially over the next 10 years. The researchers used data on cancer incidence and survival and on care costs by phase of care to develop estimates of the overall cost of care. They found that even if medical costs, cancer incidence, and survival remain static, the rapid aging of the U.S. population will cause the overall cost of care to rise from $125 billion in 2010 to $158 billion by 2020. If costs of care rise by only 2 percent annually, the overall cost of cancer treatment would rise to $173 billion by 2020, an almost 40 percent increase over the course of 10 years. Dr. Angela Mariotto, lead author of the study, and Dr. Martin Brown, chief of the Health Services and Economics Branch in DCCPS, recently spoke about this looming issue and how to address it.
These projected numbers are higher than some others recently published. Why are your estimates different?
Dr. Mariotto: Previous cost estimates have been based on older data. We used the most up-to-date Surveillance, Epidemiology, and End Results (SEER) data, from 2007, and linked SEER-Medicare data, which includes claims through 2006. The population projections we used, from the U.S. Census Bureau, were based on the period of 2006 through 2020.
Our methodology was also better than previous studies because we calculated prevalence and costs by phases of care. Initially, in the first year after a cancer diagnosis, costs are very high. If people die of their cancers, costs go up again sharply in the last year of life. In between the initial period following diagnosis and the last year of life, costs are lower.
Breaking down costs of care this way helps with overall accuracy of the projections and also helps us understand where the money is being spent. For example, one of the results from the study is that costs will likely increase substantially for breast and prostate cancer survivors in the period between diagnosis and the last year of life, simply because those are two of the three most common types of cancer. Costs per patient are very low in the survivor phase, but the fact that we will have such a large number of patients drives up the total cost.
The first generation of baby boomers will turn 65 this year, and people 65 and older have the highest incidence of cancer. Is this aging cohort inflating the costs of cancer care only in the short term?
Dr. Brown: It’s probably true that if we were to project out to, say, 2040, we would see a trend of costs not going up as quickly, or maybe even going down, though the further out you get in these kinds of projections the more uncertainty there is in general. But baby boomers like me may still be around in 2040, so we’re talking about a pretty distant horizon before costs even begin to taper.
We’ve seen an overall decline in cancer incidence as a recent trend. How will this influence your projections?
Dr. Mariotto: The main driver of the rise of medical costs associated with cancer is the aging of the U.S. population. If cancer incidence continues to decline as it has, then that may mitigate the increase in total costs—and we estimate them to be $148 billion in 2020 instead of $158 billion. However, survival has improved in the last decade, and if it continues to improve, that will again increase costs. We are planning to do longer-term prevalence projections in an upcoming study to get a better idea of what year prevalence and costs will begin to decline.
Previous studies have shown that the per-person costs of cancer care are actually higher for people younger than 65 than for older people, probably because doctors tend to use more aggressive care in younger patients compared with the older population. We still need better data to estimate costs in the younger population and are actively planning to gather these data and develop studies to improve cost estimates in the younger population.
These numbers indicate a growing burden on an already strained medical system. Are there any obvious areas of care we could improve in a way that may, at the same time, potentially decrease cost?
Dr. Brown: The idea of comparative effectiveness research has potential in our health care system for improving the quality of care, and perhaps increasing savings. There are a lot of big questions about effectiveness in cancer treatment left to answer. For example, in early-stage prostate cancer, we still haven’t answered in a randomized clinical trial which treatment approach is most effective: radiation, surgery, or watchful waiting.
Then there are related important questions inside of every big question. Say, if radiation therapy turns out to be the best option, there are four or five different kinds of radiation treatment available, and these vary dramatically in cost. If it turned out—and obviously we don’t know this yet—that a less expensive type of treatment is just as good as or even better than some of the more expensive modalities, that would be an example where we could identify savings that will make a real difference for our health care system, because prostate cancer is one of the most commonly diagnosed cancers.
There are many areas of cancer medicine where we still don’t know what the best care really is, or where we do know that the way we’re doing things currently is quite inefficient. I think we literally have to look at the evidence in every area of cancer medicine. We have to know which treatment approaches are more or less effective and then identify changes to improve the quality of care and cancer outcomes.